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Benca E, van Knegsel KP, Zderic I, Caspar J, Strassl A, Hirtler L, Fuchssteiner C, Gueorguiev B, Windhager R, Widhalm H, Varga P. Biomechanical evaluation of an allograft fixation system for ACL reconstruction. Front Bioeng Biotechnol 2022; 10:1000624. [PMID: 36406221 PMCID: PMC9670106 DOI: 10.3389/fbioe.2022.1000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to compare the biomechanical stability, especially graft slippage of an allograft screw and a conventional interference screw for tibial implant fixation in ACL reconstruction. Twenty-four paired human proximal tibia specimens underwent ACL reconstruction, with the graft in one specimen of each pair fixed using the allograft screw and the other using the conventional interference screw. Specimens were subjected to cyclic tensile loading until failure. The two fixation methods did not show any statistical difference in load at graft slippage (p = 0.241) or estimated mean survival until slippage onset (p = 0.061). The ultimate load and the estimated mean survival until failure were higher for the interference screw (p = 0.04, and p = 0.018, respectively). Graft displacement at ultimate load reached values of up to 7.2 (interference screw) and 11.3 mm (allograft screw). The allograft screw for implant fixation in ACL reconstruction demonstrated comparable behavior in terms of graft slippage to the interference screw but underperformed in terms of ultimate load. However, the ultimate load, occurring at progressive graft slippage, may not be considered a direct indicator of clinical failure.
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Affiliation(s)
- Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
- AO Research Institute Davos, Davos Platz, Switzerland
- *Correspondence: Emir Benca,
| | - Kenneth P. van Knegsel
- AO Research Institute Davos, Davos Platz, Switzerland
- Department of Orthopedics and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos Platz, Switzerland
| | - Jan Caspar
- AO Research Institute Davos, Davos Platz, Switzerland
| | - Andreas Strassl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Christoph Fuchssteiner
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Harald Widhalm
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Varga
- AO Research Institute Davos, Davos Platz, Switzerland
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Farago D, Kozma B, Kiss RM. Categorize the existing clamps used for tensile test of human graft- a systematic review. BMC Musculoskelet Disord 2022; 23:707. [PMID: 35879684 PMCID: PMC9316330 DOI: 10.1186/s12891-022-05650-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The use of tendon allografts for orthopedic repair has gained wide acceptance in recent years, most notably in anterior cruciate tendon reconstruction. Multiple studies support the use of tendon allografts and the benefits of its use are well accepted and understood. One of the important criteria of the use of tendon allografts is statistically similar histological and biomechanical properties to autographs. The aim of this systematic literature review is to investigate and categorize existing clamps used in the determination of the biomechanical properties of tendons such as maximum load, maximum strength, modulus of elasticity, ultimate strain, and stiffness. A variety of clamps for use during the endurance test of tendons were categorized according to the temperature used during the measurement. The clamps are divided into three groups: room temperature, cooled and heated clamps. The second goal of our review is to overview of clamps on the following aspects: name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters, and summarize in Table 3, as a comprehensive catalogue. Methods This systematic review was carried out in keeping with the PRISMA 2020 E&E and the PRISMA-S guidelines and checklists. A search was conducted for publications dating between 1991 and February 28th 2022 through three electronic databases (Web of Science, Scopus, and PubMed). We used Critical Appraisal Skills Program checklist to check the quality of included articles. Results The database search and additional sources resulted in 1725 records. 1635 records eliminated during the screening for various reasons (case report, other languages, book chapter, unavailable text/conference abstract, unrelated topic). The number of articles used in the final synthesis was 90. A variety of clamps for use during the endurance test of tendons were identified and categorized according to the temperature used during the measurement. Based on this, the clamps are divided into three groups: room temperature, cooled or heated clamps. Conclusions On the basis of the systematic literature review, mechanical parameters determined by usage with cooled clamps proved to be more reliable than with those at room temperature and with heated clamps. The collected information from the articles included name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters given in Table 3. summarized. The main advantage of the cooled clamps is that there is no limit to the type and length of the tendon. This study provides an overview of clamps and does not represent the modernity of any method. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05650-w.
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Affiliation(s)
- Denes Farago
- Cooperation Research Center for Biomechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary. .,Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Blanka Kozma
- Department of Biomedical Engineering, SUNY University at Buffalo, Buffalo, USA
| | - Rita Maria Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
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Panagopoulos A, Mylonas D, Kouzelis A, Zampakis P, Kraniotis P, Lakoumentas J, Gliatis J. No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients. Arthrosc Sports Med Rehabil 2021; 3:e1155-e1163. [PMID: 34430896 PMCID: PMC8365223 DOI: 10.1016/j.asmr.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare anterior cruciate ligament (ACL) autograft reconstruction using fixed-looped suspensory versus expandable femoral fixation through the anteromedial portal. Methods After we performed prospective power analysis and obtained institutional review board, 70 patients with ACL rupture were block randomized to the expandable or suspensory femoral fixation group (35 in each group). All patients received autologous hamstring autograft through the anteromedial portal and fixed with a sheath-screw system in the tibia. The primary outcome measures were anteroposterior knee stability at 2 years’ follow-up measured using the KT-1000 arthrometer and the degree of femoral and tibial tunnels’ widening measured by the use of computed tomography imaging performed immediately postoperative and 12 months postsurgery. Secondary outcome measures included pain score on a visual analog scale, the subjective International Knee Documentation Committee 2000 assessment form, the Lysholm score, and the Tegner activity scale at 3, 6, 12, and 24 months. Results Twenty-four patients were excluded from further analysis, leaving a total of 48 patients (24 in each group) for the final evaluation. The anteroposterior knee stability (KT-1000) showed no difference between groups at 24 months’ follow-up (P = .31). The percentile widening (%) of femoral and tibial tunnel at 1-year follow-up showed no difference also, except for greater values at the tibial coronal point T2 (P = .065) and tibial sagittal point T1 (P = .033) in the group of cortical buttons. Secondary clinical outcomes showed no statistical differences between groups at 3, 6, 12, and 24 months’ postoperatively. Numerical pain scale (visual analog scale) was similar in both groups except for postoperative day 7, where the AperFix group showed better results (P = .014). There were no major intraoperative and late postoperative complications in any of the groups. Conclusions Our results showed no significant differences in knee anteroposterior stability, tunnel enlargement or other clinical outcomes comparing expandable versus cortical button fixation in anteromedial hamstrings ACL reconstruction. Level of Evidence Level II, randomized controlled trial.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Dimitris Mylonas
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Antonis Kouzelis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Petros Zampakis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - Pantelis Kraniotis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - John Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - John Gliatis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
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Vertullo CJ, Cadman J, Dabirrahmani D, Appleyard R. Can tape-screw fixation of a quadrupled semitendinosus graft in a full-length tibial tunnel provide superior fixation compared with a doubled semitendinosus-gracilis held with an interference screw? A matched-pair cadaveric biomechanical comparison. J Orthop Traumatol 2018; 19:11. [PMID: 30128979 PMCID: PMC6102157 DOI: 10.1186/s10195-018-0495-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 01/24/2018] [Indexed: 01/11/2023] Open
Abstract
Background In anterior cruciate ligament reconstruction, quadrupled semitendinosus (Quad ST) grafts have potential advantages over doubled semitendinosus–gracilis (ST/G) including larger diameter and gracilis preservation, however the ideal tibial fixation method of the resultant shorter Quad ST graft remains elusive if a fixed-loop suspensory fixation device is used on the femur. We investigated whether the tibial fixation biomechanical properties of a Quad ST fixed indirectly with polyethylene terephthalate tape tied over a screw in a full outside-in created tunnel was superior to a ST/G graft fixed with an interference screw. Materials and methods In a controlled laboratory study, six cadaveric matched pairs of each construct were subjected to cyclic loading to mimic physiologic loading during rehabilitation. This included preconditioning cycling, cyclic loading to 220 N for 500 cycles, then cyclic loading to 500 N for 500 cycles. Results High standard deviations across the measured parameters occurred with no significant difference between measured parameters of elongation for the different constructs. Elongation of the Quad-ST construct was greater at 10 and 100 cycles, but not statistically different. Four of the six Quad-ST constructs failed below 100 cycles, compared with two failures below 100 cycles in the ST/G construct. There was a strong correlation between cycles to failure and bone mineral density for the Quad ST-tape constructs. Conclusions Tibial fixation of Quad ST with a tied tape–screw construct in a full-length tunnel was not biomechanically superior to ST/G graft fixed with an interference screw, exhibited greater nonsignificant construct elongation with earlier failure, and was more reliant on bone mineral density. Level of evidence In vitro laboratory study.
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Affiliation(s)
- Christopher J Vertullo
- Knee Research Australia, 8-10 Carrara St, Benowa, Gold Coast, QLD, 4217, Australia. .,Gold Coast Orthopaedic Research and Education Alliance, Griffith University, Gold Coast, QLD, 4215, Australia.
| | - Joseph Cadman
- Faculty of Medicine and Health, Macquarie University, Sydney, 2109, Australia
| | - Dané Dabirrahmani
- Faculty of Medicine and Health, Macquarie University, Sydney, 2109, Australia
| | - Richard Appleyard
- Faculty of Medicine and Health, Macquarie University, Sydney, 2109, Australia
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Martel O, Garcés GL, Yánez A, Cuadrado A, Cárdenes JF. Can an expansion device be used in anterior cruciate ligament reconstruction? An in vitro study of soft tissue graft tibial fixation. Knee 2016; 23:1049-1054. [PMID: 27802926 DOI: 10.1016/j.knee.2016.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/20/2016] [Accepted: 06/20/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to compare the mechanical properties of an interference screw with an expansion device in anterior cruciate ligament (ACL) reconstruction. METHODS A total of 52 porcine tibia and 20 polyurethane foam blocks (0.16g/cm3) were used. Forty pullout tests were carried out to combine the two types of bones - surrogate and porcine - with the two fixation systems: interference screw and expansion device (n=10 per group). Thirty-two cyclic tests (n=8 per group) were carried out with both fixation devices in porcine bone at two different force amplitudes (100N and 200N). RESULTS Stiffness and load values (mean±SD) at six millimeters of displacement for the expansion device and the interference screw were 74±33N/mm, 318±135N, and 52±28N/mm, 205±70N, respectively, showing a difference in stiffness (P=0.016) and load at six millimeters of displacement (P=0.001). No correlation between insertion torque and the ultimate failure load was found for both fixation devices tested. In cyclic tests, significantly higher (P<0.001) numbers of cycles (mean±SD) were reached with the expansion device (81,014±30,291 at 100N; 13,462±11,351 at 200N) than with the interference screw (15,100±8623 at 100N; 343±113 at 200N) at six millimeters of displacement. CONCLUSION The use of an expansion device for ACL reconstructions seemed to be a promising alternative to an interference screw. Insertion torque alone was not a useful predictor of graft fixation strength in ACL reconstructions.
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Affiliation(s)
- Oscar Martel
- Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Gerardo L Garcés
- Department of Medical and Surgical Science, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Alejandro Yánez
- Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Alberto Cuadrado
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan F Cárdenes
- Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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Mechanical testing of newly developed biomaterial designed for intra-articular reinforcement of partially ruptured cranial cruciate ligament: ex vivo pig model. ACTA VET BRNO 2014. [DOI: 10.2754/avb201483010055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The study deals with mechanical testing of newly developed material polyethylene terephtalate coated with polycaprolactone nanofibers in combination with biodagradable Hexalon ACL/PCL screws as a new possibility of intra-articular reinforcement of partially ruptured cranial cruciate ligament. Four groups ofex vivomodels of pig stifle joints were prepared and tested: a model with intact CCL (group 1), a model with partial CCL rupture (group 2), a model with CCL rupture stabilized with 7 mm Mersilene®strip (group 3), and a model with CCL rupture stabilized with 5 mm PET/PCL biomaterial strip (group 4). The models were loaded in the standing angle of 100° and the maximum load (N) and the shift (mm) were monitored. The mean maximum peak power and the shift were 1266.0 ± 146.9 N and 13.7 ± 2.5 mm for group 1, and 1164.7 ± 228.2 N and 1 6.8 ± 3.3 mm for group 2, respectively. In all cases after reaching the maximum load, a tibial fracture occurred but never a CCL rupture. In groups 3 and 4, the initial fixation failure occurred in the mean values of 375.7 ± 81.5 and 360.4 ± 52.0 N, respectively, and with a bigger shift of 52.3 ± 11.9 mm and 39.4 ± 14.6 mm, respectively, compared to group 1. A critical point of failure was the anchoring in the bone. It can be concluded that the PET/PCL substitute in theex vivomodel has mechanically comparable properties with the clinically used Mersilene®,and based on its proven ability to carry stem cells it could be appropriate for partially ruptured CCL protection.
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Wijdicks CA, Michalski MP, Rasmussen MT, Goldsmith MT, Kennedy NI, Lind M, Engebretsen L, LaPrade RF. Superficial medial collateral ligament anatomic augmented repair versus anatomic reconstruction: an in vitro biomechanical analysis. Am J Sports Med 2013; 41:2858-66. [PMID: 24036572 DOI: 10.1177/0363546513503289] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND When surgical intervention is required for a grade 3 superficial medial collateral ligament (sMCL) tear, there is no consensus on the optimal surgical treatment. Anatomic augmented repairs and anatomic reconstructions for treatment of grade 3 sMCL tears have not been biomechanically validated or compared. HYPOTHESIS Anatomic sMCL augmented repairs and anatomic sMCL reconstruction techniques will reproduce equivalent knee kinematics when compared with the intact state, while creating significant improvements in translational and rotational laxity compared with the sMCL sectioned state. STUDY DESIGN Controlled laboratory study. METHODS Eighteen match-paired, fresh-frozen cadaveric knees (average age, 52.6 years; range, 40-59 years) were each used to test laxity of an intact sMCL, a deficient sMCL, and either an anatomic augmented repair or an anatomic reconstruction. Knees were biomechanically tested in a 6 degrees of freedom robotic system, which included valgus rotation, internal and external rotation, simulated pivot shift, and coupled anterior drawer with external rotation. RESULTS Anatomic augmented repairs and anatomic reconstructions had significantly less medial joint gapping than the sectioned state at all tested flexion angles and showed significant reductions in valgus rotation compared with the sectioned state at all flexion angles. No significant differences between the anatomic augmented repair and anatomic reconstruction were found for any test performed. Despite the similar behavior between the 2 reconstruction groups, neither technique was able to reproduce the intact state. CONCLUSION Anatomic sMCL augmented repairs and anatomic sMCL reconstructions were not significantly different when tested at time zero. Both the anatomic augmented repair and the anatomic reconstruction were able to improve knee stability and provide less than 2 mm of medial joint gapping at 0° and 20° of flexion. CLINICAL SIGNIFICANCE These results suggest that both an anatomic sMCL augmented repair and an anatomic sMCL reconstruction improve knee kinematics compared with a deficient sMCL and provide equivalent joint stability.
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Affiliation(s)
- Coen A Wijdicks
- Robert F. LaPrade, The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657.
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